Wheelchair Athletes: Performance & Injury

The Paralympic Games are the pinnacle of sport for many athletes with a disability.

A potential issue for many wheelchair athletes is how to train hard to maximise performance while also reducing the risk of injuries, particularly to the shoulder due to the accumulation of stress placed on this joint during activities of daily living, training and competition.

The overall purpose of this narrative review was to use the constraints-led approach of dynamical systems theory to examine how various constraints acting upon the wheelchair-user interface may alter hand rim wheelchair performance during sporting activities, and to a lesser extent, their injury risk.

As the researchers found no studies involving Paralympic athletes that have directly utilised the dynamical systems approach to interpret their data, the researchers used this approach to select some potential constraints and discussed how they may alter wheelchair performance and/or injury risk.

Organism constraints examined included player classifications, wheelchair setup, training and intrinsic injury risk factors. Task constraints examined the influence of velocity and types of locomotion (court sports vs racing) in wheelchair propulsion, while environmental constraints focused on forces that tend to oppose motion such as friction and surface inclination.

Finally, the ecological validity of the research studies assessing wheelchair propulsion was critiqued prior to recommendations for practice and future research being given.

Conclusions

As the number of wheelchair users who are participating in wheelchair sport is growing worldwide, it is important to increase the understanding of the biomechanics of wheelchair propulsion to improve performance and decrease the risk of injury. The constraints-led approach is a useful tool when examining the outcome and coordination of a hand rim wheelchair user’s movement, and will assist the Paralympic athlete and coach better develop their overall training programme.

No single constraint can be considered in to isolation, so how the three levels of constraint interact is paramount to understanding wheelchair propulsion performance and injury risk during sport. The interaction of organism constraints such as players’ disability, classification level and chair set up will likely be important factors to consider when developing the appropriate training programme required by a wheelchair athlete to perform at their best whilst also reducing the risk of injury.

It is evident that while wheelchair athletes in racing and court sports all need to accelerate and achieve high speeds, they have very different task constraints that need to be considered, along with environmental constraints such as friction both between the user and wheelchair and wheelchair and ground. Unfortunately, very little empirical evidence is available on what constitutes appropriate training for these different groups of Paralympic athletes’ and how they may use functional variability when adapting their propulsion biomechanics to the variations in environmental conditions.

It is clear that much of the literature is almost 20 years old, based on using wheelchairs on ergometers, and even using able bodied individuals as subjects. Much research still needs to be done to fully understand the biomechanics involved in hand rim wheelchair propulsion in sport especially with the ever evolving wheelchair technologies. This research needs to use the appropriate subjects, be performed in ecologically valid, real-world environments and investigate the vast array of wheelchair sports that are now available.

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